Provider Demographics
NPI:1295955177
Name:LEE, JAMES W (DMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 BRUNSWICK RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9544
Mailing Address - Country:US
Mailing Address - Phone:530-274-2507
Mailing Address - Fax:530-274-2539
Practice Address - Street 1:563 BRUNSWICK RD
Practice Address - Street 2:SUITE 6
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9544
Practice Address - Country:US
Practice Address - Phone:530-274-2507
Practice Address - Fax:530-274-2539
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0331141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice